Provider Demographics
NPI:1942391081
Name:ROMAN, DENNIS JOHN (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOHN
Last Name:ROMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SAINT JAMES ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2341
Mailing Address - Country:US
Mailing Address - Phone:860-308-6336
Mailing Address - Fax:
Practice Address - Street 1:4 FARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2573
Practice Address - Country:US
Practice Address - Phone:860-284-5213
Practice Address - Fax:860-284-5333
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist